SSAD

The Society for the Study of Addiction held it's annual meeting yesterday and today - the title "If we did have evidence based policy and practice, what would they look like?"
I'm afraid that there weren't too many clear answers to the question - largely because policy is in the hands of the policy makers.

Alcohol was a case in point - there is now a large body of evidence (UKATT and Project Match) to support brief interventions in people with hazardous or problematic drinking, but policy is slow to support with funding for these brief interventions, perhaps because the alcohol industry is at the table when it comes to formulating alcohol policy. Anyway, one thing that came out of Jane Marshall's excellent talk was that I bought a book she has co written about alcohol treatments. Perhaps I will report back on this in the future.

Robert West spoke admirably on the evidence for effective quit smoking strategies. He reminded me that in people with low seizure risk bupropion is an option and that although unlicenced, in the person not at risk of OD, nortriptyline 75-150mg has been shown to be effective. Nicotine replacement therapy is effective, and although it is not licenced, he suggested that an acute delivery system could be co-prescribed with a chronic delivery system, eg gum and patches together! Telephone councelling of the proactive sort has some benefit but reactively is not useful. The best results are achieved with combining either NRT or bupropion/nortriptyline with behavioural support and can achieve a 15% cessation rate at 6 months. He added the titbit that there is some evidence that those who suddenly decide to quit mid pack seem to do better than those who decide and set a date, so that our smoking cessation clinics need to be able to respond to such an individual who is suddenly in need of support. Finally he mentioned 2 new drugs that might be heading our way - Varenicline - a "false tobacco" and Rimobant.

In the short papers section Duncan Raistrick presented on a comparison of lofexidine vs buprenorphine detoxification. There was little to chose between the two but the service users voted with the feet and those who refused randomisation elected for buprenorphine. Nicky Metrobian and Nick Lintzeris presented information on injecting rooms in London. These are just being established and a trial of effectiveness in process. Intriguingly they claimed that in toxicological screens they could distinguish between street and prescribed heroin, but gave no further details on this.